Ep 218 Substance Use Disorder in the ED – Stigma, Compassion and System Change

About this episode

This episode discusses the stigma surrounding substance use disorder in emergency medicine and explores ways to improve care for affected patients.

Emergency physicians pride themselves on recognizing and treating life-threatening illness under pressure. Yet one of the most lethal, common, and treatable conditions presenting to our EDs still often receives fragmented, stigmatized care: substance use disorder. The opioid crisis has evolved into an era of increasingly toxic and unpredictable drug supplies, including ultra-potent synthetic opioids such as nitazenes. Between 2016 and 2021, more than 27,000 Canadians died from opioid toxicity, while opioid-related ED visits continue to rise sharply. Patients discharged with untreated opioid use disorder face mortality rates approaching 5% within 12 months. Despite this, substance use disorder is still not consistently approached with the same urgency and systems-based care as other chronic high-risk illnesses. In this episode, Dr. Bjug Borgundvaag, Tish Mizon and Kari Herbert discuss how stigma affects care in the ED and how trauma-informed communication, person-first language, compassionate care, peer navigators and Bridge-style addiction programs can improve outcomes for both patients and clinicians. Please support EM Cases ongoing Free Open Access Medical Education learning…

People in this episode

Host: Dr. Anton Helman

Guests: Dr. Bjug Borgundvaag, Tish Mizon, Kari Herbert

Topics covered

• substance use disorder
• emergency medicine
• opioid crisis
• stigma in healthcare
• compassionate care
• system change

Keywords

• substance use disorder
• opioid crisis
• emergency department
• stigma
• compassionate care
• trauma-informed communication
• peer navigators
• addiction programs

Mentioned in this episode

Organizations: Emergency Medicine Cases

Places: Canada

More episodes of Emergency Medicine Cases

• Journal Jam 24 Antibiotics for Strep Throat: Evidence, Myths and Misperceptions · June 2, 2026 · 1h 19m
• Ep 217 Pediatric Agitation: Assessment and Management · April 28, 2026 · 1h 22m
• Ep 216 Cardiac Arrest Update: Beyond the 2025 ACLS Guidelines Part 2 – Medications, Airway, Termination and Post-ROSC Care · April 7, 2026 · 1h 42m
• Ep 215 Cardiac Arrest Update: Beyond the 2025 Guidelines Part 1: CPR, Defibrillation and Ventilation · March 25, 2026 · 1h 53m
• EM Quick Hits 71 EMC²: Fever Without a Source, Coaching the EM Mind Part 1, Traumatic Pneumothorax Part 2, PECARN C-spine Rule, Medetomidine Withdrawal, EMS Handover · March 10, 2026 · 1h 39m
• Ep 214 Bridging the Gap in Endometriosis Care: Recognition, Risk Stratification, and ED-Initiated Management · February 25, 2026 · 56 min